UR/CASE MANAGER

Brunswick Hospital Center•Amityville, NY

10d•$24 - $27

About The Position

The Psychiatric Utilization Reviewer oversees assigned hospital patients to ensure they continue to meet medical necessity according to InterQual criteria. The role involves chart audits, clinical rounds, and direct observation. The reviewer conducts utilization reviews and coordinates with insurance companies and hospital staff to support patient care, treatment, and authorization. The position requires accurate EMR documentation, compliance with hospital protocols and HIPAA, and completion of appeals and retro-authorizations as directed by the UR Director.

Requirements

Excellent communication skills.
Attention to detail.
Bachelor’s degree; a BSN is preferred, or a master’s degree in BSW, LMSW, or LMHC.
Knowledge of behavioral health, including DSM-5-TR.
Knowledge of Microsoft Office, Excel, and Outlook.
Ability to work as part of a collaborative hospital team.
Experience working with electronic medical records.

Nice To Haves

BSN preferred.

Responsibilities

Conduct initial, concurrent, and discharge utilization reviews with insurance companies for in-house psychiatric patients.
Obtain pre-certification for new patients who were not already authorized by the sending facility.
Determine and convey medical necessity for each patient according to InterQual criteria.
Collaborate regularly with UR staff, social workers, providers, and other hospital staff regarding patient care, treatment, and authorization.
Access and use the EMR while maintaining high standards of documentation and following protocols.
Work professionally as part of a team to support compliance with hospital policies and patient care standards.
Understand and comply with HIPAA rules and regulations.
Complete appeals and retro-authorizations as directed by the UR Director.